Stage 4 skin cancer, in the context of the provided reference, means the cancer:
- Is any size.
- Has spread to one or more lymph nodes.
- Has grown through the outside covering of one of the lymph nodes, and/or has spread to distant sites in the body.
The reference provided focuses specifically on the characteristics of stage 4 skin cancer rather than just a generic skin lesion. Therefore, the answer is in the context of skin cancer staging.
